Mapping the Evidence on Kratom Use, Health Outcomes, and Policy Gaps in the United States: A Scoping Review

Kratom use in the US is subject to a variety of social factors that influence public perceptions, one of which being that users themselves have a perceived lower social rank and socioeconomic status. Attitudes are additionally shaped by the legal ambiguity and variability in access regarding kratom, with some users viewing kratom as a safer, natural alternative to traditional opioids, while others report concerns about product quality, addiction potential, and overall regulatory uncertainty. Media coverage, advocacy groups, and online communities play a significant role in further affecting public perceptions, often emphasizing the therapeutic benefits of kratom use while minimizing the risks. Despite this, users’ willingness to disclose kratom use is largely impacted by the ever-present stigma associated with substance use, alongside the lack of educated physician opinions regarding the use of kratom in either recreational or clinical contexts. Knowledge gaps in kratom’s health effects furthermore contribute to overall perceptions, as the current body of research has a clear paucity of reliable information on the safety and efficacy profile of kratom. Given the complex landscape currently surrounding kratom, the present paper aims to explore commonly reported patterns and motivations in kratom usage in US adults, as well as understand the psychosocial and behavioral outcomes resulting from kratom usage and identify barriers hindering access to this potentially critical resource. Our review intends to highlight the gaps in knowledge, education, policy, and resource-oriented research to provide regulatory guidance on kratom application. With such, our paper contributes toward a stronger foundational understanding of kratom as both a pharmacological entity and a recreational substance, through which the need for accurate, widespread, specific, sensitive, and effective testing of kratom products will be underlined.